Validation of the online Toddler Autism and Development Adaptive Screener (TADAS) at 18 months

项目摘要摘要 美国儿科学会已强制自闭症(ASD)从 基于自闭症儿童早期干预改善的证据，进行为期18个月的常规访问 结果。然而，美国预防工作组并未在一定程度上认可这一建议 因为有效性数据有限。这项研究建立在我们小组的一系列研究基础上，目的是 改善自闭症的早期识别。我们已经开发了一种有前途的新颖而高效的筛选器 初级保健被称为幼儿自闭症和发育适应性筛查(TADAS)。塔达斯一家 使用机器学习开发，以自动确定要从父级收集哪些项目 每个案例都基于前一个项目中社区样本的数据。目前使用的自闭症 筛查人员有ASD或发育迟缓(DD)迹象的儿童失踪率很高 过度推荐率也是有问题的，代价也很高。我们先前研究的数据显示，塔达斯有 敏感度(.94比.32)和相似的特异度(.87比.90)几乎是目前的三倍 推荐和最受欢迎的自闭症屏幕(M-Chat-R/F)和两倍以上的灵敏度 (.94比.39)和类似的特异度(.79比.85)目前的标准年龄和 阶段调查问卷-3 tm。TADAS还提供了更高的效率，因为难以实施 建议的后续访谈不是必需的，家长负担较小 物品。这项建议是为在线交付的TADAS编程，然后根据诊断测试进行验证 对于ASD和DD来说，在一个新的社区样本中，来探望他们18个月的Well儿童的儿童 与我们最初的研究相比，更好地反映了美国人口的种族、民族和社会经济地位 人口。如果我们的初步结果在这项研究中得到进一步验证，筛查早期ASD和DD 可能会更有效，通过更早的时间相应地改善儿童的结果 干预。该项目的一个附带好处是提供了一种高效的计算机自适应测试语言 基于可独立使用的现有国家语言能力数据进行筛选 语言障碍的学步儿童，有患自闭症和一般自闭症的风险 初级保健中的语言筛查。这些创新的新工具是在网上创建的 临床支持系统，称为CHADIS，具有辅助整个过程的附加功能 及早识别、转介和跟踪。CHADIS为患者提供个性化的教育 家长；临床医生使用将初级保健与早期干预联系起来的护理协调软件 具有共享数据和跟踪结果选项的服务；以及供医生接收的选项 参与自闭症筛查质量改进所需的董事会重新认证学分 努力。对临床医生、保险公司、市政当局和各州有价值的最终产品和“护理系统”。

Project Summary Abstract The American Academy of Pediatrics has mandated identification of autism (ASD) beginning at the routine 18-month visit, based on evidence that early intervention for children with autism improves outcomes. However, the US Preventive Task Force has not endorsed that recommendation, in part because of limited validity data. This study builds on a series of studies by our group aimed at improving early autism identification. We have developed a promising novel and efficient screener for primary care called Toddler Autism and Development Adaptive Screen (TADAS). The TADAS was developed using machine learning to automatically determine which items to collect from the parent in each case based on data from a community sample in a previous project. Currently used autism screeners have high rates of missing children who have signs of ASD or Developmental Delay (DD) and also problematic and costly rates of over-referral. Data from our prior studies showed that TADAS had nearly three times the sensitivity (.94 vs .32) and similar specificity (.87 vs .90) to the currently recommended and most popular screen for autism (M-CHAT-R/F) and more than twice the sensitivity (.94 vs .39) and similar specificity (.79 vs .85) for developmental delay of the current standard Age & Stages Questionnaire-3tm. The TADAS also provides greater efficiencies since a difficult-to-implement recommended follow-up interview is not required and there is less parent burden in overall number of items. This proposal is to program TADAS for online delivery then validate it against diagnostic testing for ASD and DD in a new community sample of children coming for their 18-month well child visit that better reflects the U.S. population in racial, ethnic and socioeconomic status than our original study population. If our initial results are further validated in this study, screening for early ASD and DD could be much more effective with corresponding improvements in child outcomes through earlier intervention. A side benefit of the project will be an efficient Computer Adaptive Testing language screen based on existing national language abilities data that could be used independently to both track language impaired toddlers who are at risk for later development of autism as well as for general language screening in primary care. These innovative new tools are being created within an online clinical support system, called CHADIS that has additional features to assist in the entire process of early identification, referral, and tracking. CHADIS provides individualized patient education for the parent; clinician use of care coordination software connecting primary care with early intervention services with options to share data and track outcomes; as well as options for doctors to receive required Board re-certification credits for participating in autism screening quality improvement efforts. The final product and “system of care” of value to clinicians, insurers, municipalities and states.